Philadelphia, PA (March 29, 2011) – In critically ill children with pneumonia, delays of even a few hours to treatment with the correct antibiotic can mean more days in the hospital, reports a study in the April issue of The Pediatric Infectious Disease Journal. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
The results highlight the need for “early and appropriate” antibiotic treatment for critically ill children in whom bacterial pneumonia is a possibility, according to the study by Dr. Jennifer A. Muszynski of Nationwide Children’s Hospital, Columbus, Ohio.
Delays to Correct Antibiotic Linked to Longer Hospital Stay
The researchers analyzed 45 infants and children, median age 17 months, who developed severed pneumonia requiring mechanical ventilation between 2004 and 2006. (Children with viral pneumonia or hospital-acquired pneumonia were excluded.) For each child, the time to treatment with the “correct” antibiotic for the bacteria causing pneumonia was assessed.
When treating children with suspected bacterial pneumonia, doctors need to make a quick decision about antibiotic treatment. They choose an “empiric” antibiotic based on the likely cause of the infection. Meanwhile, tests are performed to confirm that the chosen antibiotic will actually kill the causative bacteria. If not, the patient is switched to the correct antibiotic as soon as the test results are in.
In the study, 71 percent of children with pneumonia were initially treated with the correct antibiotic. Including children whose antibiotic was changed after bacterial testing, the median (midpoint) time to treatment with the correct antibiotic was about 10 hours, with a range of 2 to 38 hours.
Silicone breasts implants have been extensively studied due to concerns about possible adverse health effects. Based on reports linking ruptured implants to autoimmune diseases, the FDA banned silicone implants in 1992. The ban was lifted in 2006, when repeated studies failed to confirm the association with autoimmune diseases.
With adjustment for severity of illness, children with shorter times to correct antibiotic treatment spent fewer days in the hospital. One child died of pneumonia caused by antibiotic-resistant staph bacteria (methicillin-resistant Staphylococcus aureus, or MRSA).
About half of the children had pneumonia as their only medical problem. For this group, longer times to correct antibiotic treatment were associated not only with longer hospital stay, but more time in the ICU and more time on mechanical ventilation.
Delays as short as 2 to 4 hours were associated with a longer hospital stay. For example, a 6-hour delay to treatment with the correct antibiotic was linked to 1 additional day on mechanical ventilation and 2 additional days in the hospital, with most of that time spent in the ICU.
The optimal timing of antibiotic treatment for children with severe pneumonia is unclear. Studies in adults suggest that the key issue is the time to treatment with an antibiotic effective in killing the bacterial cause of pneumonia.
“Ours is the first study of the associations between timing and selection of empiric antibiotics and outcomes in critically ill children with bacterial [pneumonia],” Dr. Muszynski and colleagues write. The results confirm the importance of prompt treatment with the correct antibiotic, showing increased length of hospital stay for children with even relatively short delays to effective treatment.
The researchers note that, for most children with prolonged times to correct antibiotic treatment, “this was not due to administration of an incorrect drug, but rather to a delay in administration of the first dose of antibiotic.” They emphasize the importance of prompt, appropriate antibiotic treatment “in children with acute respiratory failure for whom an infectious [cause] is a possibility.”
About the The Pediatric Infectious Disease Journal®
The Pediatric Infectious Disease Journal® (http://www.pidj.com) is a peer-reviewed, multidisciplinary journal directed to physicians and other health care professionals who manage infectious diseases of childhood. The journal delivers the latest insights on all aspects of infectious disease in children, from state-of-art diagnostic techniques to the most effective drug therapies and other essential treatment protocols. The Pediatric Infectious Disease Journal is official journal of the Pediatric Infectious Diseases Society and the European Society for Pediatric Infectious Diseases.
About Wolters Kluwer Health
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
Wolters Kluwer Health is a division of Wolters Kluwer, a leading global information services and publishing company. The company provides products and services for professionals in the health, tax, accounting, corporate, financial services, legal, and regulatory sectors. Wolters Kluwer had 2008 annual revenues of €3.4 billion ($4.9 billion), employs approximately 20,000 people worldwide, and maintains operations in over 35 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Amsterdam, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Visit www.wolterskluwer.com for information about our market positions, customers, brands, and organization.
Contacts:
Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com
Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com